Psychiatry and Clinical Psychopharmacology

Gender dysphoria and autoscopic hallucinations: a case report

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S351-S351
Read: 1070 Published: 17 February 2021

Autoscopic phenomena refer to a cluster of reduplicative visual illusions concerning one’s own body and self. In autoscopic hallucination or autoscopy, patients perceive a replica of themselves within space from an internal point of view as in a mirror. Here, we report the case of a female patient with gender dysphoria; experiencing frequent autoscopic hallucinations, which she describes as her own dead body violently mutilated in several ways. The case has been found noteworthy in terms of the probable relationship between the presentation of autoscopic hallucinations and unrevealed gender dysphoria. A18-year-old female patient was admitted to our clinic by the chief complaints of seeing the image of her own dead body in external space and a chronic sense of meaninglessness. This image had first appeared three months ago, at a time when she began to live separately from her family and she broke up with her significant other. She stated that this image looked like a copy of herself in the current state; a pale dead body in the same clothes but covered with blood, with wrists cut, sitting still in a corner of the room. This image had not disappeared for about twenty minutes and was still there even she looked elsewhere and turned back her gaze upon it. Within time, she had begun to see this frightening image of her own dead body in different forms (hanged on a tree, stabbed, etc.) and public situations (dining with friends, travelling on a bus etc.). She reported once that, when the image appeared; she decided to touch it in order to check its reality, and became extremely frightened as she felt its coldness on the tips of her fingers. Suddenly, she convinced by the idea that seeing this image required her death; yet she attempted suicide by taking medication. After discharge from emergency room, the patient was admitted to psychiatry outpatient unit and was medicated with risperidone and clonazepam combination. The patient’s visual hallucinations disappeared within days. Following hospitalization, detailed physical examination and laboratory tests including EEG, cranial CT and psychoactive drug screening were performed to rule out epilepsy and other medical conditions. As the clinical interviews advanced, it has been understood that the patient suffered from an unrevealed gender identity disorder, so that she felt herself belonging to the opposite sex since childhood; she had been embarrassed about physical changes on her body during adolescence and had tried to obtain a masculine appearance by masking her secondary sex characteristics in several ways. She stated that she felt simply stuck in the wrong body and avoided looking in the mirror, when naked because of her disgust against it. We hypothesized that gender dysphoria which remained hidden due to patient’s socio-cultural limitations may have triggered episodes of depression; based on feelings of helplessness. Moreover, feelings of anger and aversion towards her own body causing avoidance of mirrors may have prepared the ground for these autoscopic hallucinations as well.
 

EISSN 2475-0581